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The Dark Side of the Nigerian Healthcare System… A Personal Experience of a Tragedy

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  There have been stories of how the healthcare system in Nigeria has been so decapitated that the need for its urgent resuscitation is of immediate implementation as an emergency. I have heard of stories of patients going through hell and being badly managed by healthcare systems and practitioners alike that I never thought that one day I will be an indirect victim of the degenerated healthcare system prevailing in Nigeria.

As usual in the Nigeria society of my time, my admission to medical school was a joy to the family and on my graduation, there was a fanfare being the first physician in my family. I do remember telling my Dad that the gain to my family of my being a physician will firstly be the fact that they will always get a very quick and reliable advice on issues concerning their health and not necessary financial gains. By irony of faith, I found myself undergoing extensive postgraduate training in Surgery in the UK and Rehabilitation Medicine with rotations through internal medicine for a year along with medical subspecialties though equipping me with a deeper knowledge of medicine in key areas of medical practice.

Over the last seven years, I have been going to Nigeria on an average of every three months with focus on direct patient care, teaching and public forum discussions. While I could not treat patients, these I had hope will allow physicians who listen to me to imbibe some etiquette and ethics in their dealings with patients. My initial obstacles including difficulty in getting registered/licensed with the Medical and Dental Council of Nigeria (MDCN) which was resolved due to the intervention of a young administrator in the Council who was magnanimous in ensuring that my registration went through without too much hassle which even took a while. Then the difficulty having a place to treat patients with its associated rigmarole in finding an hospital to do the procedures and management along with the slow pace of things that have been very frustrating to say this least.

On October 17, 2010,  I arrived in Abuja with a weeklong schedule for me to give lectures in Abuja and Lagos on both current trends in stroke management and current trends in interventional pain management. I was also scheduled to appear on Classic FM program to give a talk on Stroke prevention and management.

While in Abuja, I had paid a courtesy call on the young physician administrator to express my sincere thanks for a good job and efficiency on his part in ensuring that my license and registration were approved without the usual hindrance that others have experienced and to also pay my condolence on the death of his wife few weeks before then. In the process, I asked him what happened. The story that came out was mind-boggling and unexpected. His pregnant wife had gone into a private hospital with low blood count and otherwise hale and hearty and within 24 hours of admission, he was called that the wife had passed away. Apparently the story was that the wife was given blood transfusion and immediately the transfusion was started she experienced shortness of breath and immediate massive failure of her organs leading to immediate death. From the story, it is apparent that she must have been given the wrong blood type. In blood transfusion process all over the world, certain steps are taken to ensure that the right blood type is given to a woman especially one who is pregnant. The first is to find the blood with the right group and then to direct cross-match that blood with that of the patient. Since this is not an emergency, this is done meticulously and also because of the fact that she is a pregnant woman, the blood type should also be Rhesus negative to prevent development of Rhesus antibodies that could attack the baby/fetus.  After all these are done, the final step before connecting the blood to the patient is to ensure that the right cross-matched blood is being given to the right patient after ensuring that the blood has been appropriately labeled for the right patient. These are all simple steps that do not require high technology. From what has happened, it is obvious that someone cut corners and did not fully implement the steps leading to the wrong blood being given to the wrong patient and leading to an unnecessary death. While expressing my condolence to this young man on October 18, 2010, I did not know nor had any premonition (unusual) that another physician and hospital inefficiency in Lagos will lead to the death of a very close cousin.

On October 19, I was in Lagos and picked up by my cousin Deborah and we did the usual which is her preparing my favorite Amala and then spending time discussing issues pertaining to events around us and giving advice. In the process, I asked her about the status of her treatment for her hyperthyroid goiter and if she had followed up with her doctors in London, UK. She then told me that she was following up with a surgeon in Nigeria with plan to do the surgery a week or two later. I asked her which hospital and she had mention Eko Hospital in Lagos. I did not ask questions about the surgeon mainly because I had no much idea about physicians generally in Lagos and believed that my cousin must have made the necessary inquiries. I felt comfortable with the hospital knowing that there is a chain of command/hierarchy along with training of junior doctors that allows a constant presence of physicians and experienced after-care nurses. I had in passing asked her why she did not follow up with her doctor in UK but her answer was that she has been assured that the doctor is experienced and that she is actually paying him about N750,000 for the thyroidectomy. I believed that her answer was to calm my fear and to assure me that the surgeon has been checked out and that she was paying premium money for the surgery(by Nigeria and even UK standard). On October 20, I gave the classic FM interview in Lagos and then flew to Abuja immediately and later that day gave the lectures. I returned to Lagos the following day and spoke to her briefly and also on October 23 after the lectures in Lagos.

Classical Thyroidectomy surgery by itself is an old surgical procedure that is apt with my dangers due to the surrounding structures that are vulnerable to damage. Historically, the way to avoid damaging those organs involved carefully looking out for them and separating them before cutting. The young trainee-surgeon is always asked to describe the anatomy of that area and recant all possible complications before he or she is given the knife at the beginning of the training to do such surgeries. The thick tissue surrounding the thyroid gland in that part of the neck can also be suffocating if blood is formed(from post-operative bleeding) after surgery. It is in lieu of this bleeding that thyroid surgery closure of the skin was done with clips and not suture to enable anyone one around the patient without surgical skill to take out the clips and let out the blood and preventing its collection from suffocating the patient to death. There is an historical perspective to this that was taught to all medical students in Nigeria during my days and this was of a VIP patient in the 1960s who had the surgery and developed the bleeding complication and before the surgeon could drive to the hospital to remove the stitches, that VIP was dead. A clip removal which could have been done by anyone could have saved that patient's life. The essence of using clips for such surgery has since become the gold standard of care for such surgery. The main nerves that supply the vocal cords and major arteries going to the brain and coming from the heart are also very near the area of surgery for thyroidectomy. Damage to the nerve that supplies the vocal cord could lead to partial paralysis of the vocal cords that can then lead to hoarse voice and a full paralysis could lead to the vocal cords closing and therefore difficulty in breathing in and out since the vocal cords are at the entrance to the airway into the lungs. There are newer techniques for modern thyroid surgery that use modern technologies to monitor the nerves, blood vessels, etc with very minimal approach that allows the patient to even be discharged much early from hospital.

On October 26 flying out of Abuja(a BA flight that departs circa 8.45 am) and back to the states, I had called my cousin to let her know that I was leaving Nigeria and back to the US. She did not pick up her phone but she later called back and then informed me that she had the surgery the day before(her voice sounded a little hoarse but I attributed that to being early morning and the fact that she just woke up). This was shocking because I had thought that she was going to wait and also shocking was the fact that the surgery was done in a hospital on Olowu Street, Ikeja and not Eko Hospital as I had thought. Knowing this, I was happy and congratulated her for a successful surgery but because my flight was about to depart, I did not have much time to ask further questions. On paper, I had a 2-hour transit time in London which with delay turned to less than an hour and therefore I did not have time to call her and hoped to call her on my arrival in Washington DC. On my final arrival, the shock was a voice message from another cousin in Los Angeles(the older of the two cousins of same parents) who left a message sobbing that things went wrong with Deborah and that I should call her. I had a sudden fear that made me to turn my phone off and afraid to listen to the rest of the message. I called my wife who confirmed my fear that my cousin had died that evening.

I am yet to get the full story of what could have occurred as I was told that the surgeon went incommunicado immediately after the death. But the few information I gathered was that she complained of sever onset of pain around her neck and the nurses took ages to eventually come to her by which time she became short of breath. All attempts to resuscitate failed.

There is no doubt that negligence in care is the main contributory factor to the death a bubbling and energetic 40 year old who walked into the hospital for what was supposed to be an easy elective surgery but ended up dead about 36 hours later. In the legal field, the prove of Negligence does not always require all the elements of Duty of care, breach of that duty of care, causation and injury which are all present in this instance anyway but also by the principle of Res ipso Loquitor which basically means that ' The Thing speaks for itself' and refers to a situation when it can be assumed that a person's injury can only be caused by the negligent action of another party because the accident was the type that could not have happened unless someone was negligent.

The issue here is the deplorable state of Nigeria's healthcare system where internationally acceptable standard of care is not followed, where regulation of the practice of medicine is by itself neglected in a situation where the physicians themselves are being allowed to police themselves, where there is no financial or legal repercussions for such negligent acts on the part of a physician who has knowingly and purposely decided to cut corners in order to increase his profit margin and in the process put the life of a young woman in fatal jeopardy. I do believe that part of cutting corners may include going to this cheaper hospital in Ikeja as against the Eko Hospital and also not doing all the necessary post-operative care and managing all expected complications within the realm of such type of surgery.

The need for the Medical and Dental Council of Nigeria to regulate the activities and performance of doctors is hereby demanded. The need to also enforce continuous medical education for physicians cannot be over emphasized. The era of a specialist qualification not expiring and lasting ad infinitum should also be abandoned because in the UK and the US, specialist qualifications only last 7-10 years after which one has to sit for the specialist examinations all over again. Also most states require evidence of continuous medical education of at least 50 hours in 2 years to enable a license to be renewed. As someone one who has specialist qualification in 6 different areas of medicine, maintaining these hours of continuous medication education has been followed to the letter and sitting for the specialist examination early to prevent their expiring has also been followed. It is inevitable that as I get older, I may opt to remain focused on 1 or 2 of the specialist practice and may then let the other 4 expire and not practicing such specialties.

In Nigeria, this is not the case as the older physicians while going around touting experience have actually lost currency in ideas and skills that some of them should be out rightly banned from ever practicing medicine, definitely not as specialist.

There is also need for the state to look at the criminality in the actions of doctors who negligently or recklessly perform surgeries or actions that lead to the death of their patients and the need for such physicians to be prosecuted and let them face the consequences of their actions.

Developed societies have also in the past gone through what Nigeria is currently going through and made changes including what I mentioned above and also allowing more lay persons to form majority in the medical boards that look into licensing physicians to practice medicine. Members of the public are allowed to contact the medical boards and file complaints against physicians. This allows non-members of the profession in the board to protect the interest of the public as against members of the profession in the board protecting their profession. In most of my round of lectures in Nigeria, I have always warned from my experience as a physician and a lawyer that if Nigeria based physicians do not start taking steps to regulate themselves and exposing the charlatans among them, other extraneous sources in the society will be forced to take steps to regulate the medical profession.

I am not wasting time talking about what government can do or not do because the current political climate in Nigeria is messed up, headless and without direction and asking a government that cannot even provide basic security for its citizens or portable water for them to provide more for health will be like asking God to send manna from heaven. I focused on the need of the medical profession in Nigeria to buckle-up and meet a certain acceptable basic standard of care that does not require any high technology. As a licensed Nigeria physician, I know this is doable. As a foreign-based Nigeria, I know that the standard of care current prevailing in Nigeria is not acceptable and the reason why I still go there and teach hoping that someone out there will see the light.

I will definitely miss my cousin who left a 7 year old daughter behind. I was in shock for the first few hours and then wept which I had not done for years for a very promising life that was cut down by the greed and incompetence of another in a system reminiscent of the jungle where everyone for himself and God for us all.

Adieu Deborah as she is buried tomorrow. Adieu to all those who lives have been cut short due to an incompetent and bastardized healthcare. God who gives is also the one that takes as he is the one that knows best.       

By Segun T. Dawodu (